Deliberate Planning: Clinical Communication in Perinatal Psychiatry

Veerle Bergink, MD, shared practical guidance on clinical communication, shared decision-making, and pointed out underutilization of lithium in postpartum psychiatric care.

Bergink emphasized that clinicians should not panic when encountering a pregnant patient on psychotropic medication, and that—with the notable exception of valproate—"it is best to pause, make a plan, and not panic and stop immediately, but think about it." She encouraged providers who may not have reproductive psychiatry expertise to schedule a dedicated appointment to discuss medication in pregnancy, review the current evidence with the patient, and refer to a specialist if needed.

Bergink placed equal clinical weight on the psychological dimensions of this counseling encounter. She observed that women frequently experience guilt regardless of the treatment decision they make—whether they continue or discontinue medication—and argued that reassurance is a core clinical responsibility in both directions. She also addressed parental anxiety about neurodevelopmental outcomes, noting that many psychiatric conditions are in the vast majority of cases unrelated to perinatal medication exposure.¹

Bergink also addressed lithium, stating that women with bipolar disorder or a history of postpartum psychosis are at extremely high risk of serious illness after delivery. She noted that lithium, which is supported by the strongest evidence base for both prevention and treatment of postpartum psychosis, remains significantly underutilized in contemporary psychiatric practice.²

Dr Bergink is a professor of psychiatry and director of the Women's Mental Health Center at the Icahn School of Medicine at Mount Sinai.

References

1. Fitch J. Meta-analysis finds no causal association between antidepressant use in pregnancy and neurodevelopmental disorders. Contemporary Pediatrics. May 15, 2026. Accessed May 15, 2026. https://www.contemporarypediatrics.com/view/meta-analysis-finds-no-causal-association-between-antidepressant-use-in-pregnancy-and-neurodevelopmental-disorders

2. Jairaj C, Seneviratne G, Bergink V, et al. Postpartum psychosis: a proposed treatment algorithm. J Psychopharmacol. 2023;37(10):960-970.